I Don't Save Lives

When I tell people what I do for a living, I generally get one of two responses. The first is the nodding head accompanied by some form of the phrase "Oh, that's cool." I generally assume that these are the kind folks who, for the sake of social norms, asked me about myself without really wanting to know the answer. It's the same as when you ask someone "How are you?" Unless you are a medical provider, you aren't really looking for them to tell you about their hemorrhoids and how they're having difficulty getting an erection.

The second response, however, goes something like "Oh, wow! You save lives!" That's far better for the ego. I've thought about this many times throughout my career. "Saving lives " sounds so noble and so heroic. Upon hearing this phrase I picture myself shirtless with six pack abs and bulging biceps (neither of which I have ever had) standing atop a mountain of smoldering debris. The near -lifeless body of some individual lies draped across my arms and my head and chin are tilted up to the single ray of sun that is beaming through the clouds of smoke and ash. If you're normal, your visceral reaction to the picture I just created should lie somewhere between mild amusement and abject disgust, and if you're in EMS you should be chuckling at the sheer ridiculousness of the "saving lives" notion.

I define "saving a life" as providing an immediate, competent medical intervention for a person who, had the intervention come even slightly later, would have perished due to their condition. I have been on the job for 22 years and have served in many capacities. I can probably count on both hands the number of times I have "saved a life." These are the calls you never forget. They're like the one good golf shot you make over the course of 18 holes - they make you come back to play again. But if those moments are so few and far between, some will ask "Why then, old paramedic, do you keep coming back after so many years?" It's a fair question, and the answer lies in the rethinking and re-phrasing of the traditional "saving lives" idea.

I reached this conclusion several years ago after asking myself a very similar question. I was cleaning up the back of a rig after a particularly annoying call, and I wondered "If everyone is going to die someday, have I really saved any lives? Is my job really that important if all I do is save lives?" I asked those questions because I knew that I hadn't really saved all that many lives in the true sense of the term. I'd taken hundreds and hundreds of calls and treated many, many patients, but real saves? Very few. The more I considered this the more my mind began to churn and it finally spat out this idea: We don't save lives. We Grant Moments. I was shocked at this notion because it almost came from somewhere outside of my head - as if someone had spoken it into my ears. I knew it immediately to be true, however. We indeed hand out moments.

Let me explain what I mean by that. When we "save a life" it is patently obvious. One minute the patient is dead or dying, and the next they are alive and well. There's not much else that we could call this exciting but rare situation. But if most of our dead or near-dead patients don't ever wake up and walk again, what good have we done by achieving ROSC? What good have we done by giving glucose to a hypoglycemic patient with terminal cancer? Indeed, what good have we done by assessing the absolutely normal elderly woman and then leaving her home? The answer is that we have granted moments.

When your patient experiences ROSC and you transport him to the ER, he may still have pulses when you arrive. He may be admitted and spend his last few days on a ventilator in the CCU, but his family gets to see him alive. He is warm. He is quiet and not suffering. They can hold his hand, speak to him, pray over him. The importance of this time should not be underestimated. Having those minutes or hours with a dying loved one is beyond priceless, and your care in the field granted those moments.

What about the moments beyond that which are granted to a young person awaiting a transplant? While your patient may ultimately die, your work in getting him to the hospital alive gives that young person a new liver or a new set of lungs - and a second chance. She'll get to graduate. She'll get to marry and perhaps even have children. She'll spend more time with her family and friends and the blissful moments which arise from that are immeasurable and may resonate infinitely into the future.

Let's say your patient doesn't get pulses back. You sit down with the family and gently explain that their loved one has died, and your masterful handling of that situation grants moments of peace. You can bring order to that chaos by calling other family, contacting clergy, helping find numbers for funeral homes, or just being present and comforting while they mourn. People will remember those moments as terrible, but not as terrible as they could have been because you were there for them.

Some patients don't really need EMS intervention. They call because they do not know what to do about a particular situation they've encountered. These are the calls most people dub "ridiculous" or "abuse of the system" and some may well be. However, when you arrive (you had to go anyhow) the way you approach that call has implications in many areas. Don't ever discount the pain of being alone and afraid.

Thom Dick writes:

"Anyone who has ever been truly alone-- absolutely without anyone who cares whether they live or die--knows what an emergency that can be. If you've never had that experience, take a moment to count your blessings. When somebody is so lonely that the only person they can call is a 9-1-1 dispatcher, that's an emergency by any definition. They're not abusing the system. They're pathetic, and they're the kind of folks we're here for."

If you remember, there was a time when we were children. Our parents (hopefully) took care of every detail of our lives, and we had peace knowing they were there. When we were sick or afraid, they comforted us. They laid down with us and held us tight. They gave us chicken soup and medicine and helped the pain go away. They chased away boogie men and monsters and made sure the house was locked up at bedtime. We've never felt more safe and more loved. As time went on, the source of that care and love may have shifted to a significant other or to friends. Perhaps we have children of our own and they receive some of that love and peace from us.

Nevertheless, as we age and as we lose people in our lives, the count of persons who can provide for us that warmth and sense of security dwindles. Yet that child lives within us still - crying out for the hug from Mommy. How painful it must be for those who have nobody left to provide that feeling of safety. If we walk in the door with our EMS bag and cardiac monitor and begin to realize that this human being we are dealing with has called looking for some sense of peace, who are we to deny that to them? Who are we to leave the frightened child with nothing but rolled eyes and a snide remark? We can, through our understanding and patience, quell the tides of anxiety at least for a few moments. Maybe the elderly woman falls asleep with a smile on her face for the first time in months because you took the time to care - those are, again, priceless moments.

In every interaction we have, we can grant moments of peace. With every patient, there is an opportunity to give away a few moments of our time so that they can gain a few for themselves. Sometimes that's all it takes to change the world - a few moments. So I have stopped saying that I save lives, and I'll occasionally correct people when they speculate that I do. "Not so much." is my wry-smiled response. "I grant moments."  What an amazing power we've been given as EMS providers.

Take a few moments to consider that.